| NPI | 1326250762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015126) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3904) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901017310) | |
| 1223G0001X Dentist, General Practice (Licence: TX 25210) | |
| Enumeration Date | 2007-05-06 |
| Last Update Date | 2022-02-07 |